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ready. Set. Take Charge Worksheet

 

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Health Care Coverage

Keeping It. Getting It. Using It.

Keeping your health insurance coverage after you become an adult is very important and completing the necessary paperwork can be time-consuming. It is best to prepare ahead of time in order to make sure that your medical coverage continues when you become an adult.

The type of medical coverage you have as a child may change once you become an adult. What type of coverage you have as an adult will depend on many different things; for example, if you are attending college, disabled, or transitioning from foster care. You may qualify for a public medical assistance plan such as Medi- Cal. California has many public medical assistance programs in addition to Medi- Cal, including California Children’s Services (CCS), Healthy Families, and the Genetically Handicapped Persons Program (GHPP).

Whatever medical coverage you have, it is important to be aware of the rules and requirements necessary to continue receiving coverage into adulthood. The following information is very general, so please make sure to review and access the list of sources to get more details on the programs outlined below.

Medi-Cal (Medicaid)

Medi-Cal is California’s Medicaid program. This is a public medical assistance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, children in foster care, pregnant women, and low income people with specific diseases. You automatically receive Medi-Cal if you are currently on Supplemental Security Income (SSI), a Social Security Program providing monthly cash benefits to youth and adults with certain types of disabilities. Your local County Welfare Department handles all Medi-Cal applications for individuals who are not on SSI.

Medi-Cal benefits are different for children than they are for adults. Once you turn 18 or 21 years old, some of the benefits you receive may change. In addition, if you are on SSI cash benefits before the age of 18, a different definition of “disability” is used for adults than for children. SSI will review your medical condition when you turn age 18 to see if you meet the adult definition of disability. Depending upon the result, you may or may not continue to receive SSI and Medi-Cal as an adult. For more detailed information on the SSI Program, check out the Financial chapter of this toolkit.

Before your 18th birthday you should consult with your Medi-Cal Eligibility Worker, Social Security Representative, Managed Care Health Plan, Primary Care Doctor, or Nurse Case Manager to see what benefits you are entitled to and how you are going to receive those benefits.

A lot of people on Medi-Cal are worried about what is going to happen to their benefits once they start working and earning money. But don’t worry – there are a lot of different work incentive programs that can help you keep your Medi-Cal benefits while you are working! For more information, check out the “Employment” section in this toolkit.

Medi-Cal rules and regulations can often be very difficult to understand and getting help before you turn 18 or start working will make for a smooth transition.

What Medi-Cal Means to You

www.sfhp.org/files/PDF/community/assistor_resources/reference_materials/What_Medi-Cal_Means_To_You_Brochure_Medical.pdf

What Are My Medi-Cal Choices

www.sfhp.org/files/PDF/community/assistor_resources/reference_materials/What_Medi-Cal_Means_To_You_Brochure_Medical.pdf

County Offices to Apply for Medi-Cal

www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

The Medi-Cal Working Disabled Program

www.chiip.org/pdf/CHIIP-MWD_6-08.pdf

Disability Benefits 101

www.disabilitybenefits101.org
Plain language information on all the different public and private disability benefit programs in California

California Children’s Services (CCS)

CCS is a statewide program that arranges, directs, and pays for medical care, equipment, and rehabilitation when these services are authorized by the program. Services can be authorized for children and young adults  under 21 years of age who have CCS-eligible medical conditions and whose families are unable to pay for all or part of their care. CCS defines eligibility and selects the most qualified professionals to treat your CCS-eligible condition. However, it is important for you to know that CCS will not meet or pay for all of your health care needs. CCS covers only those health care needs related to your CCS-eligible condition.

CCS coverage stops on your 21st birthday. You may be eligible for other public medical assistance programs after your 21st birthday and it is a good idea to begin planning for your continued coverage as early as possible. Ask your CCS Nurse Case Manager for assistance with your transition of health care needs.

Family Handbook: What Parents/Guardians Should Know About California Children’s Services (CCS)

www.dhcs.ca.gov/formsandpubs/publications/Documents/CMS/pub387.pdf

Healthy Families Insurance Program

www.healthyfamilies.ca.gov

The Healthy Families Program is for children only. Healthy Families medical coverage includes, health, dental and vision to children who do not have health insurance. Healthy Families covers children and young adults up to their 19th birthday.

Genetically Handicapped Persons Program

www.dhcs.ca.gov/services/ghpp/Pages/default.aspx

GHPP is a health care program for adults with certain genetic diseases. GHPP provides complete health care services to its clients. Unlike other programs, the GHPP covers services even if they are not related to the treatment of the GHPP-eligible medical condition. The approval of these services is subject for individual review based on medical need.

Healthcare Reform

As a person with a disability, the new Affordable Care Act can possibly help you with your health insurance concerns.  Under the new law, you can remain eligible for coverage under your parents insurance until you reach 27 years of age.  Additionally, if you have been denied medical coverage because of a pre-existing condition, and you have not had health coverage for the past six months, you can now re-apply for health care coverage without the fear of being denied.  

The new law requires that insurance plans would be required to cover rehabilitation services, durable medical equipment, prosthetics, orthotics and related supplies, vision and hearing services and behavioral therapy.  Mental health coverage would also be expanded for individuals covered under large group plans. Another change that takes place is that insurers can no longer deny or put a spending cap on your coverage.
To see a brief fact sheet that covers all of the changes which may affect you, please visit: www.healthcare.gov/news/brochures/people-with-disabilities-top5.pdf

Family Coverage

Most health coverage under your parent’s work plan ends when you turn 19. You may still be covered under your parents’ plan:

  • for a few more years, up to 25 or 26 years of age
  • if you are a full time student
  • if you are disabled and need your parents to support you

But plans do vary. Be sure to find out which of these applies to you.

Health Coverage through Work

Many employers offer health insurance, but most will also require that employees pay for part of it and require that you work a certain number of hours each month. The amount will be deducted directly from your pay check, and although it may seem like a lot, it’s far less than what you could pay in the ER or for a day in the hospital if you had to pay the full price. You’ll likely have options to choose from t work, so be sure and review the “Resources” section in this guide for information on choosing the best plan for your needs

Health Coverage While in College

Going away to school may make it impossible to see the doctor you usually see in your hometown. Make sure to check with your insurance plan to see if it allows you to switch to a doctor close to school and then switch back when you’re back home again. Some insurance plans don’t allow this; they will only cover visits with your primary care doctor in your hometown, so be sure and ask about your options. There are a lot of other things to keep in mind regarding your health care when going away to college — read the section “College and You” for more useful tips.

 

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